Chronic Low Back Pain: The Powerful Influence of Fear
Chronic low back pain is a common presentation we see at our clinic that frequently has a significant mental and emotional component tied to it, more so than many other conditions. Unfortunately our society at large and many healthcare providers often unintentionally instill fear in us about back injuries. When someone we trust tells us, “You have a bad back,” or “There is degeneration in your spine,” or “You have a slipped disc,” or “You shouldn’t squat or deadlift anymore,” it instills a significant amount of fear. Fear for the physical safety of our spine, fear for the overall function of our body, and fear of feeling forced to let go of the activities we enjoy doing. Let me very clearly state that YOU DESERVE BETTER from your healthcare provider.
These broad, fear-based statements are not in any way helpful. Sure, you may have degeneration in your spine, but degeneration occurs in every joint in the human body; even if we are the perfect picture of health, our bodies will experience this as we age and the spine is not exempt from that. Sure, you may have recently strained muscles in your low back lifting; every muscle in our body can be strained if loaded improperly with poor form or too much resistance, but it will heal and can be strong again. For comparison: does someone with repeated (chronic) ankle sprains get told to never walk, climb stairs, jump, *insert verb* again? No. So why would someone with chronic back pain be told to never squat, hinge, lift again? It is illogical. There are certainly times when we need to scale back activity, resistance levels, or specific movements to support the healing process of the body, but unless a serious injury (e.g., vertebral fracture, severely herniated disc) has been diagnosed via imaging, then you can safely work with someone like a physical therapist to guide and to support you back to your prior functioning.
In primary care settings, of all people who report low back pain, 50% of them have elevated levels of fear. Research also supports the concept of chronic low back pain and correlations with fear. One example is a study that showed that the fear we have about pain, not even the pain itself, is associated with avoidance behaviors (avoiding movements we *think” will cause pain) and is also associated with experiencing chronic low back pain. The vicious cycle is something like this: fear about moving - less movement - decreased mental health - more anxiety and fear about moving…
There are many complexities at play between motion, pain, and fear of pain, and their effects at both the hips and the spine. Having high (or relatively “good”) lumbar mobility was found to be correlated with decreased pain-related fear, but interestingly enough was not found to have any correlation with actual pain itself. Alternatively high hip mobility was found to be correlated with low pain, but no correlation was found with pain-related fear. In consideration of hip flexion mobility (e.g., the movement when you lift your leg going upstairs), this specific motion is associated with higher levels of chorionic low back pain. Many people do not know that some of the muscles that do hip flexion actually attach to our low back, so addressing them can be key in your treatment process.
Another key movement at the low back that is associated with high experiences of pain-related fear is forward bending tasks such as a deadlift, bending over to pick your kids off the ground, lifting a heavy bag of groceries off the floor, bending over while gardening, etcetera. Does this sound like something you have been avoiding or have had to modify due to pain or fear?
There is a methodology called the Common Sense Model. It addresses how our sense-making process influences our coping abilities and outcomes in chronic conditions, such as low back pain. When we experience something like low back pain, we try to make sense of it in our brain. This is impacted by our existing beliefs, prior experiences, and more. Our representation of pain influences our response to it. If we feel our low back pain is uncontrollable, threatening, untreatable, that can cause fear and anxiety around the pain situation; the “‘common sense” response in this situation would be to avoid whatever feels threatening to our body, thus contributing to fear-avoidance behaviors.
When experiencing a triggering or painful event, ask yourself:
What is this pain?
What caused the pain?
What are the consequences of the pain?
How well can I control the pain?
How long will this last?
As clinicians, it is so important to provide space and education to reduce the fear that is such a major contributor to chronic low back. Similar to every condition we treat, we will provide you with a thorough evaluation and diagnosis, explain your symptoms and why they are there, provide guidance on how to take control over the symptoms, what to do to make them better, and what to do to keep them from coming back again. When you feel or think you may be having a fear response to pain, consider what you can do in that moment to take control over your worry. Shift the focus to take back your power in the situation.
Have more questions about taking control over your back pain? We would be happy to chat further about how Loon State Physical Therapy can be your teammate in getting you back to moving and feeling your best! Call us at (612) 405-8503 or book with us online at www.loonstatephysicaltherapy.com for an in-person or virtual appointment.
Bailey Van Oosbree, Doctor of Physical Therapy
Loon State Physical Therapy